Environment and Ecology Research 7(3): 153-170, 2019
org
DOI: 10.13189/eer.2019.070305
Transforming Research Results in Food Safety to
Community Actions: A Call for Action to
Advance Food Safety in Ethiopia
Wondwossen Birke, Firdu Zawide*
Department of Environmental Health and Technology, Faculty of Public Health, Jimma University, Ethiopia
Copyright©2019 by authors, all rights reserved. Authors agree that this article remains permanently open access under
the terms of the Creative Commons Attribution License 4.0 International License
Abstract On April 7, 2015 when WHO celebrated the
World Health Day, the slogan was “From Farm to Plate,
Make Food Safe”. On this day the Jimma University
launched the campaign to create public awareness on food
safety by organizing a one-day workshop for over 100
residents representing consumers, food service providers,
government regulators, health extension workers, teachers
and community leaders. The Jimma University’s,
Environmental Health and Technology Department has
been conducting research on food safety since 2009 and the
event of the 2015 World Health Day created an opportunity
to present the research findings to the community members
in order to reach a consensus on how to transform research
results to concrete action in a participatory approach. Our
research on food safety constituted community based
cross-sectional survey of randomly selected 825
households and 718 food establishments in 13 Sub-cities of
Jimma town, Southwestern Ethiopia. Evaluation of food
safety knowledge, attitude, and practice of households and
food service establishments was conducted using pretested
and structured questionnaires for the interview. The proper
enforcement of the current food safety laws and regulations
by local government health inspectors and health extension
workers and the procedure applied was evaluated on the
basis of the critical role inspection plays in providing the
different stakeholders the education, information and
motivation necessary to make informed decisions on food
safety. Different levels of compliance of food
establishments to current food laws and regulations were
assessed including reasons for noncompliance.
Intervention measures to remove barriers to compliance
were identified and the necessary actions to be taken to
improve hygiene practices of food handlers and the
sanitary condition of food premises to prevent the outbreak
of foodborne diseases in the community were presented in
the workshop. The outcome of the workshop was
awareness creation and preparation of action plan to
improve food safety of households and catering
http://www.hrpub.
establishments in Jimma town. The study provides
evidence based food hygiene and safety behaviors of
households and micro and small food establishments that
have significant health and economic impact. The study
recommends the strengthening of the food inspection and
laboratory services; development of laboratory based
foodborne disease surveillance system, extension of the
local, regional and national information, education and
communication services and ensuring the safety of food
imports and exports. It concludes by suggesting the way
forward to advance food safety in Ethiopia with specific
recommendation.
Keywords Food Hygiene, Regulatory Compliance,
Risk Assessment, Food Inspection, Consumers Education
and Communication
1. Introduction
The rise in foodborne diseases and global food recalls
are good indicators of emerging food safety problems
which require unified approach by all countries to protect
human health and promote international trade. The issues
may vary from country to country but interventions should
start at local level. The overall aim of this research was to
reduce the burden of foodborne diseases and enhance the
health and economic benefits of safe food production for
domestic consumption and export by improving sanitation
and controlling the environmental hazards (physical,
chemical, biological) in places where food is produced,
processed, marketed, prepared and consumed. In order to
achieve this aim, there were six objectives: 1. create
awareness and promote advocacy on the rising health and
economic threats of food contamination and adulteration in
the country resulting in the increase of foodborne diseases;
2. provide evidence based situation analysis of the hygiene
154 Transforming Research Results in Food Safety to Community Actions:
A Call for Action to Advance Food Safety in Ethiopia
and sanitary condition of households and small food
enterprises including street markets to improve decision
making capabilities of policy makers; 3. assess the
effectiveness of the current food inspection system and the
enforcement of relevant food safety regulations on the
basis of compliance; 4. evaluate the knowledge, attitude
and practice of food handlers in households and small food
enterprises to improve understanding of food
contamination and spoilage in order to practice good
hygiene as preventive action; 5. identify and examine the
barriers for noncompliance and recommend appropriate
measures for the enforcement of regulations; 6. provide the
basis for developing national food safety policy, strategy
and action plan based on holistic approach and risk
assessment applying the principle of critical control points
and critical limits including the way forward and
recommendations.
This paper will present empirical evidence on the
background problem of food safety. It concentrates on the
epidemiology of foodborne diseases, bacteriological
contamination of food, and food safety risk assessment
“farm to table”. Research methodology, results, discussion
and conclusion, the way forward, and recommendations
are given in Part 2-7, respectively.
2. Background
2.1. Epidemiology of Foodborne Diseases
Food insecurity and malnutrition in all its forms
dominate government agendas and the news media in most
of the developing countries including Ethiopia. Ethiopia is
not a land of famine but potentially a rich country where
transforming just one of its fertile regions can feed the
entire nation if food safety and security are given more
attention. It is ironic that wheat tops the list of imported
food stuff in Ethiopia while there are many places in the
country which can be developed for grain production [1].
In contrast food safety is one of the essential conditions for
public health development which is not well understood
and usually overlooked by the public health authorities.
This is because the majority cases of foodborne illnesses
are not reported since the initial symptoms of most of the
diseases are not severe to require medical attention.
Although there are more than 250 foodborne diseases
caused by pathogenic organisms that enter our food chain,
the data we get from different sources on the morbidity and
mortality of the diseases arising from these pathogens is the
tip of the iceberg [2]. In 2015 WHO released the full results
of the research on a broader analysis of the global burden of
foodborne diseases undertaken by WHO’s Foodborne
Diseases Burden Epidemiology Reference Group (FERG).
The results show that there were an estimated 600 million
cases of 22 different foodborne enteric diseases and
420,000 deaths including 125,000 children under the age of
5 years. Diarrheal diseases are responsible for more than
half of foodborne diseases causing 550 million cases and
230,000 deaths every year. The African region recorded the
highest disease burden for enteric foodborne disease,
followed by South East Asia. The enteric disease agents
responsible for most deaths were Salmonella Typhi,
enteropathogenic E.coli and norovirus [3].
Epidemiological data on the burden of foodborne
diseases are meager in Ethiopia due to lack of laboratory
based surveillance system. Most foodborne illnesses are
not reported unless they occur in epidemic proportion.
Many of those reported are never traced to a particular food
or the sources and the causative agents identified. Ethiopia
has been implementing the Integrated Disease Surveillance
and Response (IDSR) strategy since the year 2000.
According to data reported on priority diseases and events
on a weekly basis by the Ethiopian Public Health Institute,
diarrhea remains the third leading cause of under-five
mortality attributed to poor water, food hygiene and
sanitation. Outbreaks of typhoid fever, acute watery
diarrhea and dysentery have been also reported from
different Regions of Ethiopia in recent years [4]. In April
2017 Ethiopia declared acute watery diarrhea (AWD) in
the Southern border with Somalia resulting in 19 deaths
mostly children and more than 700 illnesses that required
treatment [5]. Earlier in 2007 a suspected outbreak of
cholera epidemic which was reported as acute watery
diarrhea by the government resulted in 60,000 cases and
684 deaths in less than a year [6]. Annual Report of
Epidemic Diseases from a national outpatient health
facilities showed that dysentery and typhoid fever cases
were 140,867 and 323,008, respectively. Whereas the
number of annual national inpatient dysentery and typhoid
fever cases/deaths were 1,264 (16 deaths) and 3,545 (12
deaths), respectively. The extent of the problem is far
greater than what is reported since the majority of cases are
not properly diagnosed and not all people who are sick with
foodborne diseases visit health facilities.
2.2. Bacteriological Contamination of Food
Available data show that foodborne bacterial diseases
are caused in Ethiopia mainly by Salmonella spp.,
Campylobacter, Listeria, E.coli and Mycobacterium [7]. In
Ethiopia one confirmed case of cholera caused by ingesting
food or water contaminated with the bacterium Vibrio
cholerae is enough to declare an outbreak [8]. Foods of
animal origin and green vegetables that are eaten raw are
considered to be the major sources of foodborne
Salmonellosis. Several epidemiological research and case
control studies have indicated that the majority of reported
foodborne outbreaks originate in food service
establishments confirming that eating meals outside the
home is a risk factor for foodborne illness [9]. The studies
further indicate that most outbreaks associated with food
service establishments can be attributed to food workers’
 Environment and Ecology Research 7(3): 153-170, 2019
improper and unhygienic food handling and preparation
practices. This means failure to apply appropriate hygiene
and sanitation practices [10]. The deplorable sanitary
condition of the premises where food is produced, prepared
and marketed have been identified as a major source of
food contamination according to several studies on hygiene
standards of food catering establishments in large and
small towns of Ethiopia.
There are a few laboratory studies that confirm the
sources of bacterial contamination of food and the health
risk of food workers. In one study the overall prevalence of
Salmonella isolated from minced meat beef, mutton and
pork from retail supermarkets in Addis Ababa was 14.7%.
Salmonella was detected in 14.45 % minced beef, 14.1 %
mutton, and 16.4% pork samples subjected to isolation and
identification [11]. Prevalence of Salmonella in milk from
lactating cows and stool samples from humans working in
the dairy farm were 10.7% of cow, and 13.6 % of human
[12]. The prevalence of Salmonella recorded in eggs from
Kombolcha poultry multiplication and breeding farm and
market were 11.5%, from which 6.3% were found from egg
shell and 6.8% from egg content [13]. The prevalence of
Salmonella in apparently healthy slaughtered cattle (Liver,
mesenteric lymph nodes, intestinal content and carcass
swab) at Bahir Dar abattoir, at animal level were 7% [14].
Campilobacter is the leading cause of bacterial
foodborne disease worldwide resulting mainly from the
contamination of poultry or other meats, raw milk, other
milk products and surface water [15]. According to studies
of abattoirs in Addis Ababa and Debre Zeit, the overall
prevalence of Campilobacter spp isolated from meat
samples were 9.3%. The highest prevalence recorded was
21.7% in chicken meat, followed by sheep meat 10.5%,
pork meat 8.5%, goat meat 7.6%, and beef 6.2%. Among
the isolates 78% were identified to be C.jejuni, 18% were
C.coli, and 4% were C.lari [16]. Similar study in Jimma
Zone on the overall prevalence of thermos tolerant
Campylobacter spp in various food animals (cattle, poultry,
pigs and sheep) showed 39.6%. The highest isolation rate
were recorded among chicken 68.1%, followed by pigs
50%, sheep 38,%, and cattle 12.75%. Among the
thermosphilic Campylobacter isolated 70.35% were
identified to be C.jejuni, 26.6% were C.coli, and 3.1% were
C.clari. Thermophilic Campylobacters are very frequent
among various food animals in Ethiopia suggesting
possible risks of infection to people through the
consumption of contaminated animal products or through
contact with infected animals [17].
In Ethiopia the wide spread habit of raw meat
consumption is the common cause of the parasitic disease,
tapeworm Taneia and other potential foodborne illnesses as
raw meat is sold in retail butcheries that have no
refrigerating or cold room facilities. Minced meat known
as “Kitfo” is a traditional meal and is eaten raw or slightly
cooked in households and restaurants and is likely to
contribute to foodborne diseases due to poor meat hygiene.
155
Recent reports also indicate that the overall prevalence
of Listeria in retail meat and dairy products in Addis Ababa
and its surrounding towns were 27.5%. From this the
prevalence rate of L.monocytogen reported was 5.4% [18].
The report on the overall prevalence of L.monocytogen and
other Listeria species from foods of animal origin isolated
from cake, raw meat, ice cream, minced beef, fish,
unpasteurized milk and pizza in Gondar were 6.25% [19].
The presence of a small number of pathogens in carcass
meat and edible offal may lead to heavy contamination of
minced beef when it is cut into pieces, as more organisms
are added to the surface of exposed tissue. Outbreaks of
infections somehow related with poor hygiene and
consumption of contaminated food have been reported in
Ethiopia and some of them were caused by Salmonella and
Shigella [20]. Although the studies are limited sheep and
goat can be potential source of E.coli 0157:H7 for human
infection in Ethiopia as confirmed by samples taken from
fecal and skin sources. As animals and people sleep in the
same house in rural areas there is frequent contact with the
skin and excreta that transmit infection.
Various studies carried out in different parts of Ethiopia
also indicate that the environmental conditions under
which food is produced, stored, prepared and consumed at
home and in catering establishments pose a significant
public health risk. In one study bacteriological examination
of food utensils from 12 students catering services located
in 7 campuses of the Addis Ababa University, swab
samples taken from the eating plates and drinking bowls
showed the presence of E.coli and S.aures as well as a total
faecal coliforms, Aerobic mesophilic bacteria (>100
colonies/utensil). S.aures were isolated from 2.8% of
swabbed utensils and E.coli were not detected from all the
swabbed utensils. Acid and gas formation was seen in
19.4% of the examined utensils confirming the presence of
total and faecal coliform [21]. These results were
somewhat better than what was recorded from Mekele
town in which E.coli and S.aures were isolated from 18.2%
and 27.3% of the swabbed utensils, respectively [22]. And
it was comparable with the study conducted in South
Ethiopia [23]. These results indicate the sanitary deficiency
of the utensils, equipment and food contact surfaces
including the washing facility such as lack of adequate and
safe running water and detergents. However the isolation
of S.aures shows the existence of poor hygiene of the food
handlers due to contamination through air particles while
coughing or sneezing during the course of work or due to
the presence of food handlers with certain infectious
disease.
In another study a survey of 127 food handlers working
in the University of Gondar Northwest Ethiopia students'
cafeteria, Staphylococcus aures, Klebisella, E.coli, Seratia
and Citobacter were isolated from 16.5%, 5.6%, 3.1%,
1.58%, and 0.8% of the finger nails content of food
handlers [24]. Similar study in Jimma town of 105 stool
samples taken from food handlers working in one food
156 Transforming Research Results in Food Safety to Community Actions:
A Call for Action to Advance Food Safety in Ethiopia
factory, 6 were found to be infected with Shigella, which
caused an outbreak of foodborne illness [25]. In the same
study examination of the quality of water in Jimma town
revealed high E.coli count (9 per 100ml). In Bahir Dar
town S.typhi was isolated from 6 out of 25 food handlers
(24%) with history of diarrhea [26]. Similarly prevalence
of intestinal parasitic illnesses and obvious cases of active
skin and upper respiratory infections were recorded among
food handlers.
Of equal concern related to the control of foodborne
diseases in Ethiopia is the increase in antibiotics resistance
(AMR) due to extensive use of antibiotics in human health
and agriculture. The inappropriate use of antibiotics among
health providers and the food animal industry, combined
with limited understanding of AMR, has worsened
Ethiopia’s AMR. Foodborne infectious diseases of
bacterial origin are no longer treated effectively with
commonly prescribed antibiotics due to development of
drug resistant micro-organisms. Although large scale
studies on antimicrobial resistance in Ethiopia have not
been yet conducted, the available reports indicate a trend
towards increasing resistance rates among pathogens such
as Escherichia coli, Shigella spp, Salmonella spp and
Staphylococcus aures to commonly prescribed antibiotics,
including ampicillin, amoxicillin, penicillin, tetracycline
and trimethoprim/sulfamethhoxazole [27].
In 2017 the Ethiopian Anti-Microbial Resistance
Surveillance Coordinating Centre was established by the
Ethiopian Public Health Institute (EPH) under the Federal
Ministry of Health (FMOH) with the support of the
Ethiopian Food, Medicine and Health Care Administration
and Control Authority (EFMHACA) and other partners.
The AMR surveillance network will provide clinicians and
public health officers with the information they need to
identify AMR and use the best medicine to help make
people well [28]. According to the operation plan AMRS
sentinel surveillance sites submit data and isolates to the
national reference laboratory at the Ethiopian Public
Health Institute and there will be an infrastructure for data
capture and information sharing with sentinel sites that will
be established in phases nationwide with support of
international partners including the United States CDC.
The possibility of integrating foodborne disease
surveillance programme with the AMR surveillance
network should be explored in order to save cost in the
future.
It is also recognized that aflatoxin is a public health and
economic threat in several African countries due to the
contamination of crops such as maize, groundnuts and
other cereals by the toxin during harvesting and storage in
the farm. Exposure to aflatoxin due to consumption of
contaminated cereals results in human disease. Aflatoxin
B1 is the most frequently occurring subtype and is found in
most feeds and foods and highly carcinogenic causing liver
cancer in humans. According to the World Bank, the
exaggerated aflatoxin tolerance level of Maximum
Allowable Levels of four parts per million cost African
countries $670 million in annual export losses of cereals,
dried fruits, and nuts [29]. In Ethiopia a study on
Knowledge, Attitude and Practice of Farmers towards
aflatoxin in cereal crops carried out in Wolaita Zone,
Southern Ethiopia in 2017, showed that the majority of the
farmers were aware of aflatoxin and its health effect but
they were not aware of toxins other than aflatoxin. It was
reported that some individuals who drink the local
alcoholic drink “areke (Katicala)” brewed from spoiled
(infested) maize were exposed to psychosis and liver
disease in the past [30]. Factors influencing the growth of
aflatoxin on crops in the field include drought, high
temperature, high humidity, insect infestation and
inadequate crop storage practices. The absence of
monitoring the enforcement of the regulatory limits and
lack of inspection contribute to the favorable growth of the
fungus. Some of the practical methods of reducing the
health effects of aflatoxin include proper drying and
storage of crops following harvesting, control of insect
infestation, removing spoiled cereals and enforcement of
regulations that limit the maximum tolerance level in
foods.
Another food safety concern in Ethiopia is the practice
of adulterating food for financial benefits by unscrupulous
merchants and petty traders who want to make quick profit.
The deliberate mixing of milk with water, flour with
gypsum, butter with banana, edible oil with poisonous
plant derivative, pepper with clay have been some of the
reported cases in recent years. Fraudulent practices will
still continue to be on the increase especially in rural and
semi urban areas where there is no formal food inspection
to insure that food laws and regulations are enforced. This
calls for urgent action to combat fraud in the country by
exposing food adulterers to the public and punishing them
severely.
2.3. Food Safety Risk Assessment "Farm to Table"
The food supply chain from “Farm to Table” is long and
complex stretching from primary production of crops,
livestock, poultry, fish, fruits and vegetables in the field to
processed, canned, packaged, frozen and dried products,
manufactured by industries in large quantity and
distributed to supermarkets, whole sale and retail stores
and open markets. The chain continues until the food is
brought to individual homes, restaurants and other food
serving institutions and other places for final preparation
and consumption. If at any one time of these steps food is
exposed to potentially hazardous agents, pathogens,
bacteria, viruses, parasites, molds, insects, rodents, toxins,
poisonous chemicals and other contaminants there is a risk
of adverse health effect. Therefore keeping food safe is a
shared responsibility of the farmers, primary producers,
processors, distributors, retailers, food vendors, service
providers, government regulators and individual
 Environment and Ecology Research 7(3): 153-170, 2019
consumers [31]. Creating awareness among the
stakeholders about the delicacy of food and the risk factors
that expose food to hazardous substances in the supply
chain in order to reduce the burden of foodborne illnesses
remains to be a huge challenge.
In the farm food can be contaminated during harvesting
and storage by hazardous chemicals and molds (aflatoxin),
pesticides, fertilizers, herbicides which also impact the
post-harvest food loss. Other risk factors associated with
farm activities include growing of vegetables in polluted
irrigation water, slaughtering of animals for beef without
examination, milking cows with hands in unsanitary
condition, raising poultry in the open and contaminated
ground, catching fish from polluted inland fresh water or
aquaculture, and storing grains in containers that
perpetuate the growth of molds. In Ethiopia the informal
sector plays a very large role in the urban and semi urban
food retail markets. Rural farmers, petty traders and food
vendors carry their produce from distance places to the
open markets to sell their products to urban and peri-urban
dwellers. Along the way there is a risk of food
contamination by chemical and biological hazards.
Most of the informal open markets are without a
permanent built up structure but may have temporary
shades occupying space on the pavement side or municipal
open area or may be mobile moving from place to place
carrying their wares on push carts or baskets on their heads
[32]. Raw and ready to eat foods prepared and sold to the
public in the open markets are perceived as a major public
health threat because of the poor environmental condition
to which they are exposed, and the unhygienic status of the
vendors and traders. Where stalls and kiosks are not
provided, food is exposed to the sun, dust, wind, smoke,
flies and dirty surfaces with a risk of contamination by
microorganisms and other vectors. Facilities such as
running water, toilets, drainage, garbage disposal and clean
storage areas are nonexistent in most of the informal
markets. It is also recognized that mishandling and
disregard of hygiene measures on the part of the street
vendors may enable pathogenic bacteria to come into
contact with and in some cases survive and multiply in
sufficient numbers to cause illnesses to the consumers [33].
If food bought from the informal markets is not properly
cooked or washed and handled safely to ensure the
destruction of pathogenic microorganisms it would be the
cause of foodborne epidemics.
In Ethiopia most of the agricultural products are used to
meet household consumption needs. Smallholder farmers
consume food produced by themselves and take their
surpluses to the nearest market for sell in order to purchase
processed food such as sugar, flour, cooking oil, salt, spices,
rice and pasta. In rural households food is often prepared
and consumed immediately with or without left over for
storage thus reducing the risk of cross contamination and
abuse of temperature. Rural dwellers also consume more
cooked cereals and raw fruits and vegetables. On the other
157
hand urban households purchase most of their food from
open markets, grocery stores, and supermarkets. Data from
2009 household consumption survey carried out in Jimma
town show that “injera”, the staple food prepared from the
grain (Teff) flour is consumed by 99% of the respondents,
followed by cereals 48%, vegetables 28%, rice 33%, meat
33%, fish 31% and pasta 31%. In the same survey it was
found that 86% of the food was purchased from open
markets, 2% from grocery stores and 6% from private
vegetable garden [34]. Although ‘injera’ made from (teff)
flour is the preferred food, maize and wheat are also
consumed by a large number of the population. There is
considerable evidence that the urban dwellers consume
more meat, dairy products including cheese and butter,
chicken, eggs, fish, pulses, fruits and vegetables than their
rural counterparts. Studies also show that cereal
consumption is going down in urban households while
consumption of animal and processed food is going up due
to large difference in income levels [35].
Ethiopia is a fast growing economy facing rural-urban
migration problem. Due to this transition, food habits of
people is changing with more people in urban areas eating
outside the home and giving preference to ready-to-eat
food sold in the open market and small restaurants at a low
price. Current food safety and hygiene practices among
households, restaurants and street food vendors generally
demonstrate gross health risks to consumers. This does not
mean that the risk for foodborne diseases will be eliminated
but there is room for improvement to reduce the risks if
basic hygiene and sanitary practices are implemented in all
places where food is produced, processed, prepared and
consumed. This study provides a bench mark for a
nationwide alert of the prevailing health risks paused by
food exposed to various environmental hazards in the place
of production, processing, marketing, preparation and
consumption, and calls for action to improve the situation
in a concerted manner. Similar researches carried out in
Addis Ababa, Bahir Dar, Gondar, Mekelle, Agaro, Awassa
towns have concluded that the current sanitary condition of
catering establishments in large and small towns of the
country pose significant threat to public health and should
be given active and serious consideration to reduce the
burden of foodborne diseases [21, 36-41].
3. Materials and Methods
This investigation was carried out in three stages to
address the current food safety issues in Ethiopia by
choosing a study area Jimma town, 356 Km Southwest of
Addis Ababa. The first study examined the knowledge,
attitude and practices of food handling, preparation and
consumption of households, and the sanitary condition of
food catering establishments including hygiene behavior of
food workers.
The second phase of the study evaluated the compliance
158 Transforming Research Results in Food Safety to Community Actions:
A Call for Action to Advance Food Safety in Ethiopia
of the food establishments to existing food safety
regulations enforced by the local municipal and health
authorities, and the effectiveness of the present food
inspection system by environmental health officers and
health extension workers. In this process the major
constraints that limit the performance of the health
inspectors including the compliance problem of food
establishments to existing food safety laws and regulations
were identified. This was followed by developing
intervention strategy by preparing training manual on food
safety in the local language for distribution to stakeholders
in the community.
The third phase was focused on creating awareness by
launching a food safety campaign on April 7, 2015 while
commemorating the World Health Day by organizing a
training workshop for members of the community
including health inspectors, health extension workers,
government health officials, food business managers,
school teachers, street vendors, food traders and handlers.
Workshop participants were briefed about the findings of
the previous research which was the basis for the workshop,
and were given lectures on food safety. At the end of the
workshop participants held group discussion and assessed
the risks of exposure to foodborne diseases. This was
followed by drafting a strategy and action plan to reduce
the burden of foodborne diseases by improving food safety
in their community. The implementation of the action plan
is currently being monitored by the health inspectors and
health extension workers.
Methods and Procedures
Information on food safety knowledge, attitude and
practice of selected households and food service providers
in the community was gathered by completing pre-tested
questioners and conducting face to face interview. The
survey instruments were first prepared in English and then
translated to the local language (Oromia) to ensure the
validity and consistency of the content. Environmental
health professionals working in Jimma town who speak the
local language (Oromia) and familiar with their local
geography and tradition were recruited and trained for data
collection. They visited the selected households and food
establishments based on whether the respondents were
willing to participate and allow to be included in the study.
If the respondents did not wish to participate in the study,
the data collectors selected the next home or food
establishment on the list. The interview protocol and the
questionnaires were piloted to ensure questioning was
targeted and clear to understand. Respondents were assured
anonymity within the research report. The collected data
were edited and entered into a computer using SPSS
Software 20.0 version (SPSS, Inc., Chicago, III, US).
Descriptive and inferential methods were applied for data
analysis.
Ethical clearance was obtained from the Ethical
Committee of the Faculty of Public Health, Jimma
University. Then the concerned government officials in the
Sub-cities were communicated through formal letters from
Publication and Research Office of Jimma University.
Informed verbal consent was obtained from the households
and food establishments for the interviews. The interview
was conducted privately and the confidentiality of the
information received was ensured.
The outcome of the survey was evaluated and a
summary of major findings was compiled on the basis of
which food safety fact sheets and training manuals were
prepared in English and then translated into the local
language (Oromia) to create awareness and address the
major risk factors identified in the community. The
manuals were prepared based on publications and
reference documents collected from the Food and
Agriculture Organization of the United Nations (FAO);
Food Code U.S Public Health Service (FDA) 2013, and the
WHO websites.
This was followed by organizing a training workshop
on the World Health Day, April 7, 2015, the theme of
which was “Food Safety“. Senior food safety instructors
from the Department of Environmental Health and
Technology of Jimma University gave lectures on selected
food safety and hygiene issues. The presentation
stimulated discussion on participatory problem solving
approach that resulted in developing action plan and
implementation strategies to improve food safety in the
community. The outcome of the workshop was published
and distributed to participants and all other stakeholders at
a later date. The implementation of the recommendations
is to be monitored by health inspectors and health
extension workers.
4. Results
4.1. Food Safety of Households
4.1.1. Study Population Socio-demographic Profile
Out of a total of 840 households registered to participate
in the study only 825 randomly selected households were
involved in the survey which gave a response rate of 98.2%.
Among the total respondents, 42.4% were males and
57.6% females. Regarding age of respondents, 34.9% were
in the age category of 18-27; 29% in the category of 28-37;
and 36.1% were in category 38 and more years, with mean
age of 34.2 years. As far as their education is concerned,
the most numerous group 33.1% were graduates of
secondary schools (9-12 grades). Those who completed
grades (9-10) were 19% and grades (11-12) 14.1%. Those
above grade 12 who graduated from college/or university
were 14.9%. The non–formal education groups included
the illiterates 17.2%, and the semi literates who read and
write 12.4%. The primary level educated respondents who
completed grade (1-4) were 6.9% and from (5-8) 15.5%.
 Environment and Ecology Research 7(3): 153-170, 2019 159

4.1.2. Food Safety Knowledge, Attitude and Practices of The personal hygiene survey of food handlers at
Households household level showed that about 589 (71.4%) of the
Overall the great majority 99.4% (820) of household respondents wash their hands after using the toilet with
respondents showed some knowledge about potential food only 179 (21.7%) using designated wash basins for hands.
contamination sources. When asked about the specific food A mixed set of responses were evident when considering
contamination sources 99.1% indicated human waste, 99.4% the practice of washing hands before and after handling
contaminated water, 99.3% dirty utensils, 99% dust and unwrapped, raw and cooked foods. Accordingly 478
99.1% foods from infected sources. About 97.4% of (57.9%) and 526 (63.8%) of the respondents wash their
respondents mentioned that pests such as flies, cockroaches, hands before and after handling unwrapped raw foods,
and rodents also contaminate food, and 98.3% were aware respectively. Whereas 437 (53.0%) of the respondents
of negligence of storage temperature as a risk factor for wash their hands before handling unwrapped cooked foods
food spoilage. The possible contamination of food by and 512 (62.1% ) after handling cooked foods. About 537
unclean and unhealthy food handlers was recognized by (65.1%) respondents said they use separate kitchen utensils
98.8% of the respondents. Around 98.5% (721) out of 825 to prepare cooked and raw foods. Those who separated the
respondents knew that microorganisms such as bacteria storage facility and the preparation areas for raw food and
and viruses are responsible for the cause of foodborne cooked food were about 659 (79.9%) and 657 (79.6%),
diseases. However when the respondents were asked respectively. The survey also found that practices such as
whether they have heard of some of the major microbial checking food labels and washing raw vegetables, and
foodborne pathogens only 10.3 % (74) were familiar with meat before cooking was minimal 267 (32.4%) and 197
Salmonella, 11.4% (82) have heard about Shigella, 23.3% (23.9%), respectively.
(168) were aware of Staphylococcus aures, and 22.7% (164)
knew about Clostridium botulism. 4.2. Food Safety Practices and Hygiene Compliance of
The attitude of the respondents in terms of adopting Food Establishments
cleaning and sanitizing of food preparation equipment and
utensils; separating storage of raw and cooked food; 4.2.1. Study Population
avoidance of handling food with abrasive and wounded A total of 740 food establishments were identified from
hands; careful study of food ingredient labels and expiry the 13 sub-cities for the survey and all of them completed
dates; and use of separate kitchen utensils for raw and the survey format and returned on time with a response rate
cooked foods although looked favorable, their application of 100%. Out of the 740 establishments, interviews were
in the actual practice was limited. This implies that the held with managers/owners of 718 randomly selected food
respondents did not put into action what they believed was service providers. The base population included 143 hotels;
right. The food handlers did not practice what they preach. 83 restaurants; 95 cafeterias; 74 clubs; 42 bars; 72 local
Further examination showed that about 811 respondents drink bars (Tej bets); 69 butcheries; 9 dairy farms; 1
(98.3%) were in agreement that adopting adequate cleaning abattoir; 47 bread retail shops; 25 bakeries; 7 fish retail
and sanitizing procedures for utensils and food preparation shops; 51 fruits and vegetables street vendors.
equipment contributes to reducing the risk of bacterial About 445 (62%) of the respondents were females while
contamination of food. Virtually all respondents 820 the rest 273 (38%) were males. Regarding age 198 (27.6%)
(99.4%) agreed that the use of protective clothes such as were from 20-30 years; 305 (42.4%) 31-40 years; 136
clean gowns and gloves play important role in preventing (18.9%) 41-50 years, and 79 (11.1%) above 51. The
food contamination, and 816 (98.9 %) were in favor of minimum and maximum ages were 20 and 65 years,
providing proper food storage facilities to avoid spoilage of respectively, and the median age was 34 years. The
perishable food. Only 18 (2.2%) of respondents disagreed educational status of owners/managers was categorized
that food handlers with abrasive or cut hands should touch into 7 levels. Accordingly 29 (4%) were illiterate; 60 (8.4%)
unwrapped foods. With regard to the study of food labels to read and write; 68 (9.5%) between grade 1-4; 58(8.1%)
understand the ingredients and the expiry dates, about 812 between grade 5-8; 157 (21.8%) between grade 9-10; 249
(98.4 %) respondents were in agreement that this was (34.7%) between grade 11-12 and 97 (13.5%) had further
important information to consumers for food safety education after completing grade 12.
protection although most consumers do not take their time
to read the labels on the food. Surprisingly those who 4.2.2. Licensing and Ownership
agreed on eating food past its expiry date even if it smelled Part three section six of the Ethiopian Government
as long as it tasted good, was 819 (99.3%). Regarding the Proclamation to provide for safety and quality of food
risk of avoiding cross contamination of raw food (meat, refers to registration and licensing of food establishments.
poultry, fish, vegetables) and cooked food by segregating According to the Proclamation any person may not operate
the storage facility and use of different utensils and cutting a food catering service without obtaining a certificate of
boards, about 399 (48.3%) disagreed while 423 (51.3%) competence from the appropriate organ [42].
were in favor. Contrary to the Proclamation 661/2009 on Food Safety
160 Transforming Research Results in Food Safety to Community Actions:
A Call for Action to Advance Food Safety in Ethiopia
Control, it was found that out of the total 718 food service
establishments involved in this study, about 578 (80.5%)
had licenses. However only 434 (60.4%) had current valid
licenses (renewed licenses) for operation. Some of the
small food businesses in the informal sector did not require
license by law. Nearly 686 (95.5%) of the establishments
were owned privately and 32 (4.5%) belonged to
organizations. The majority of the establishments (85.7%)
were managed by owners themselves, 8.2% managed by
relatives of owners, and 6.1% managed by hired personnel.
Almost all the establishments (99.5%) were managed by
those with <5 years experiences in the food service
business.
4.2.3. Food Safety Risk Factors
The survey identified several risk factors for foodborne
illnesses in the establishments investigated. These included
lack of hygiene compliance of food workers, poor sanitary
and structural condition of food preparation and serving
places; inadequate kitchen facilities and equipment giving
rise to risks of cross-contamination, ineffective
temperature control of food storage including refrigeration
and cooling practices; unsanitary use of cutting boards,
inefficient sanitizing of utensils and food contact surfaces.
4.2.4. Knowledge and Practice of Food Handlers
Generally there was no statistically significant
difference in the knowledge, attitude and practice of food
safety between households and food serving
establishments. The majority of food handlers have
adequate knowledge regarding the main cause of food
contamination and the causes of foodborne diseases but fail
to implement basic sanitary measures to reduce the risk of
contamination. This may be due to negligence to follow the
right practice, inadequate supply of basic sanitary facilities,
lack of management support for food safety, and shortage
of time and money.
Around 80% of the food workers showed inadequate
knowledge about what was legally required of them to do,
particularly in relation to general food hygiene principles.
A large percentage (95.8 %) of the respondents reported
that they had not heard of hazard analysis and critical
control (HACCP) in the past. About 96.8% of the
establishments lacked trained staff in food safety. None of
the food workers had a certificate in food catering or took
training in accordance with the principles of HACCP or
received in house training by their employees in food
hygiene. Only 23 (3.2%) of the establishments had trained
staff in food safety and only 24 (3.3%) of food workers had
medical check-up from time to time not on regular basis.
The number of food handlers who wear protective
clothing (gown, gloves, hair restraints, hairnets) during
preparing and serving food was found to be only 319
(44.4%). Skin lesions, eye and nose discharges were
observed among some food handlers. No health education
was given to food handlers on personal hygiene such as
washing hands before and after preparing food, trimming
and keeping their finger nails clean, not wearing hand
ornaments, covering open cuts and wounds with
waterproof bandages, covering mouth when sneezing and
coughing, and reporting to health care provider or food
service manager when having diarrhea or other
communicable diseases. This has resulted in poor hygienic
practice of food handlers and increased risk of food
contamination by food workers which may result in the
outbreak of foodborne diseases.
4.2.5. Preventing Cross-contamination
In a healthy catering establishment food contact surfaces
such as food preparation tables, cooking equipment and
utensils, should be cleaned and sanitized at a given
frequency using running water. Raw fruits and vegetables
should be thoroughly washed in water to remove soil and
other contaminants; table clothes and napkins should be
replaced each time after use by a customer; towels for
drying utensils should be kept dry and not used for other
purpose; cooked food should be kept separated from raw
foods; raw and cooked foods should be kept in clean
covered containers and stored in protected location; food
with visible soil on the surface of hermetically sealed
containers should be washed before opening the containers;
containers of food ingredients should have clear labels for
ease of identification; food stuffs should be stored in dry
condition where it is not exposed to dust, moisture splash,
vectors and rodents at least 6’’ above the floor. Food must
not be stored in lockers toilet rooms, dining room, garbage
storage room and garages. All ingredients and raw
materials used for food preparation should be inspected for
quality, freshness and compliance with national standard.
These are some of the important hygiene practices
expected from catering establishment to protect consumers
from foodborne diseases [11].
In this study it was found that only in about 210 (29.2%)
of the food establishments utensils and equipment were
kept in sanitized clean condition, and cooked food was
separated from raw food in about 416 (57.9%) to avoid
cross-contamination. Only about 144 (49.7%) of the
establishments kept food contact surfaces clean and in
sanitary condition. None of the establishments used color
coded chopping boards and utensils to prevent cross
contamination (e.g. red for raw meat, brown for vegetables,
blue for raw fish, yellow for cooked meat, green for salads
and fruit, and white for bakery and dairy products). In 467
(65%) of the establishments stored food was not properly
covered and protected from contamination. In nearly 179
(50%) of the establishments, insects and rodents were seen
harboring the food preparation, storage and serving areas.
4.2.6. Temperature/Time Control
Food may be received at specific temperature as required
depending on the type of food. In this regard perishable raw
and ready to eat food (meat, poultry, fish, eggs, vegetables,
 Environment and Ecology Research 7(3): 153-170, 2019
milk) should be kept in refrigerator or freezer within 2
hours. Storing food at temperature lower than 40⁰F (5⁰C)
will retard the growth of pathogenic organisms and the
more important spoilage organisms, but it does not prevent
all changes. Proper air circulation and regular cleaning and
sanitizing of chill spaces is mandatory. Temperature for
refrigeration or freezing is determined by the kind of food,
the condition it is in, and the desired time for keeping it
under refrigeration. The bacteria that cause food spoilage
do not multiply at freezing temperature but when thawing
begins frozen food becomes vulnerable to bacteria and the
associated toxins they may produce. Frozen food is thawed
in cold running water or refrigerator or using microwave.
The storage space in the refrigerator for perishable and
nonperishable foods should be separate. Preparing food
long before it is consumed would result in temperature
abuse unless there is adequate refrigeration. Storing food at
ambient temperature after it is prepared is a major factor for
bacterial contamination and food poisoning. Several
studies show that high microbial counts were associated
with food when held at room temperature for 4 hours or
longer [11].
In this study 283 (29.4%) of the establishments had
refrigerators and 560 (78%) kept perishable foods at room
temperature. Fruits, vegetables and other food items were
also stored at room temperature in about 75.8% of the food
premises. Moreover only 37% of the respondents knew the
correct temperature for refrigeration and only 2 (0.3%)
used thermometer. None of the establishments had a
walking in type of refrigerator or built in cold store.
Most food workers feel that they don’t need
thermometers to check the temperature of the food because
they know from experience how long it takes to cook the
food, and by tasting and looking at it they can tell from the
appearance when the food is ready for serving. Taking the
temperature of every meat cooked or kept in the
refrigerator was considered to be time consuming.
Therefore there was no procedure for temperature control
in any of the catering establishments. For this reason
factors impacting holding, cooling, and reheating practices
were not evaluated during the survey.
4.2.7. Sanitary Facilities
Each food establishment registered under the formal
sector is subject to inspection and shall have premises,
facilities, and equipment according to the requirement of
the licensing authority or local health department.
Generally food service establishments should be located on
suitable sites that are easily accessible, properly drained
and free of smoke, domestic animals, rodents and other
vectors. There should be no garbage or other waste disposal
or nuisance close to the site. All public health safety
requirements should be considered in selecting the site or
when giving approval for licensing. The building should
meet the required structural safety standard to safeguard
the wellbeing of the inhabitants and consumers and ensure
161
the provision of the basic sanitary facilities such as running
water, adequate liquid and solid waste disposal. The
kitchen and dining rooms should be of adequate size and
properly lighted and ventilated free of smoke, dust and
cracks on the walls, floors and ceilings that allow the
accumulation of dust and the breeding of vectors. Floors,
drains and trenches should be easy to wash and rinse.
Materials and equipment contacting food surface should
not impart color, odor or taste to the food brought in
contact under normal condition, and should be durable, free
of corrosion, decomposition, chipping and scratching.
They should be non-absorbent, smooth and easily
cleanable, except as specified a sink with at least 3
compartments and hot water and cold water supply shall be
provided for manually washing, rinsing, and sanitizing
equipment and utensils. Tables or drain boards shall be
large enough to accommodate all soiled and cleaned items
that may accumulate during operation hours. There shall be
separate hand washing basins with hot and cold water taps,
soap and hand drying facility conveniently located for use
by consumers and food workers. Similarly there shall be
separate flush toilets for food workers and customers.
Toilet papers shall be available for cleaning all the time
whether flush toilet or dry latrine is used. Septic tanks and
pit latrines shall be located at a distance from the food
preparing and serving area and solid waste including
discarded food shall be stored in garbage container with
tight lid for final disposal at the municipal refuse dump site
or in a sanitary pit for composting [11].
Compared to the above requirements, among the
establishments inspected only 290 (40.4%) of them had
three compartment sinks for washing utensils and
equipment and the rest used single and double
compartment sinks and large containers. About 144 (49.7%)
of them kept food contact surfaces in the kitchen in a clean
condition. None of the establishments used mechanical
dish washer. In about 358(49.7%) of the establishments,
food preparation, storage and serving areas were not kept in
sanitary condition. In nearly 179(50%) of these
establishments, insects and rodents were seen harboring the
food preparation, storage and serving areas.
With regard to food waste and garbage disposal, the
study revealed that about 372(51.9%) of the establishments
inspected kept waste food in containers with fitting lid.
About 237(33%) of the establishments disposed wastes
generated from their premises properly.
Regarding personal cleansing facility, the study showed
that 540(75.2%) had running pipe water, about 181 (33.6%)
were with hand washing facilities, and 167(31%) provided
soap/detergents for hand washing. Latrine provision was
seen in about 592(82.5%) of the establishments with some
of the latrines in a smelling and unsanitary condition for
use including pit latrines. About 180 (25%) were with
adequate ventilation and 258(36%) with adequate lighting
in the food preparation area.
162 Transforming Research Results in Food Safety to Community Actions:
A Call for Action to Advance Food Safety in Ethiopia
4.2.8. Food Inspection Practices and Hygiene Compliance
In about 549(76.5%) of the establishments, food safety
inspection was being conducted by environmental health
officers and health extension workers in the past. The result
of the study showed that the majority 405 (73.8 %) of the
establishments were not inspected regularly (with fixed
time) by the health agent. The length of time after the last
inspection was found to be more than six months in 438
(79.8%) and less than six months in 111 (20.2%) of the
establishments. Regarding time spent during each
inspection, the establishments reported that the inspector
spent less than 30 minutes in 337 (61.4%) localities, 30 to
60 minutes in 193 (35.1%) establishments and more than
60 minutes in 19 (3.5%) food serving entities. Of those 549
establishments inspected the majority 376 (68.5%) didn’t
receive a written report or a copy of the completed
inspection forms that show the results.
Only 24.2% of the establishments reported that the
inspector has initiated action on the spot to correct minor
violations identified before leaving the site. None of the
establishments responded that the inspectors explain or
teach about the corrective measures to be taken during each
inspection. About 73% said that the inspector identifies
imminent health hazard which may lead to suspension of
permit unless compliance is made within a short time. 84%
answered that the inspector has reviewed the menu or food
list to check weather raw or undercooked foods are served
or sold on routine basis. Only 23% of the food
establishments’ food workers /handlers were advised of
their relevant legal obligations. Only 10% of the
establishments ever received an advisory visit from
inspectors on informal basis. None of the establishments
had ever called the health agent in case of a problem. With
regard to award schemes, none of the establishments were
encouraged for their achievement in maintaining good food
hygiene practices by awarding them certificates that rate
their food safety performance.
4.2.9. Barriers to Compliance
Several barriers to compliance of existing food laws and
regulations were identified. The major barriers were found
to be inadequate knowledge and skill about food hygiene,
lack of facilities and motivation, and limitation of
resources. Around 80% of the respondents showed
inadequate knowledge about what was legally required of
them to do, particularly in relation to general food hygiene
principles. A large percentage (95.8%) of the respondents
reported that they had not heard of hazard analysis in the
past. A large percentage (88.5%) of the respondents
reported that they hadn’t attended a food hygiene course in
the past and were not aware of the current legislation and
the type of food poisoning bacteria. About 96.8%of the
establishments lacked trained staff (food handlers) in food
safety. Only 1% of the food establishments sent staff for
food hygiene course. None of these provided in-house
training to their employees in food hygiene. None of them
had a written food safety management system devised to
monitor food safety in accordance with the principles of
HACCP or safe food practice. Food preparers wore
protective clothing in about 319 (44.4%) of the
establishments and those who did not wear was 399
(55.6%). Most of the establishments interviewed
demonstrated a lack of motivation, in particular in dealing
with the training issues.
In about 84% of the food establishments money was
perceived to be a barrier with respect to structural
compliance and training requirements. 55% of the
respondents perceived time to be a barrier preventing the
identification of regulations. Time was perceived to act as a
barrier in around 73% of the establishments for
temperature control, hazard analysis, training courses and
structural issues. Time was seen perceived to act as a
barrier in terms of documenting their hazard analysis,
keeping temperature control records, or attending higher
level food hygiene courses. The timing of the inspection
often coincided with busy period in about 60% of the
respondents, or when the proprietor wasn’t there 67%.
Only 2% of the establishments indicated that the
inspector explores opportunities for formal event for the
training of food handlers and other employees. Legal
action had been taken on about 399 (55.6%) for the
non-compliance and the rest 319 (44.4%) responded that
legal action had never been taken against their
establishments in the past. Specific legal measures were
taken against 100 food establishments including
submission of warning notes. Business was closed in 152
service places for non compliance and prosecution was
made against 147establishments. Only 22.8% of the
respondents said that the inspector has explained why food
hygiene and safety arrangements within the food business
are important to prevent foodborne diseases and why food
hygiene regulations and requirements should be applied in
a proactive way to ensure food safety control.
4.3. Transforming Research Results to Community
Actions
The results of the study showed the need for greater
intervention to apply safe hygiene practices in the
preparation of foods at home and catering establishments.
It was observed that there was a knowledge gap in
understanding existing food laws, regulations and
standards by households and food service establishments.
The need for a properly designed public health campaign to
enhance food safety at all levels was realized.
Consequently the report on food safety assessment at
household level was published and distributed to
community groups, health inspectors and responsible
public health agents. This was followed by preparing
manuals in local language on food hygiene, foodborne
diseases, major cause of food spoilage, environmental
sanitation and existing food laws and regulations. This was
to be followed by organizing a training workshop aimed at
 Environment and Ecology Research 7(3): 153-170, 2019
creating awareness about food safety in the community and
educate them on simple and practical sanitary measures to
prevent foodborne diseases.
The World Health Organization is aware of the rising
trend of foodborne diseases globally and as a result the
theme of World Health Day on April 7, 2015 was “ Food
Safety: From Farm to Plate Make Food Safe”. In
commemoration of this day the Jimma University joined
WHO by conducted a training workshop in which over 100
residents of Jimma town were drawn from different sectors
including consumer’s representatives, households, food
service providers, government regulators, health inspectors,
health extension workers and teachers. Key research
findings from the two field surveys were presented to the
participants followed by lectures in local language on food
hygiene and foodborne diseases presented by Jimma
University Environmental Health and Technology staff.
WHO’s 5 keys to safer food, environmental sanitation
standards of food establishments including licensing and
registration, risk based regulatory framework and
enforcement strategies were among the subjects for
discussion. The need to modernize existing food safety
legislation by defining the role of government, food
producers and consumers to ensure food safety from farm
to table was elaborated.
At the end of the workshop participants were able to
identify gaps and opportunities in implementing
appropriate hygiene and sanitation practices at the
household and food serving places to ensure the safety of
consumers. The workshop provided the participants a
platform to exchange knowledge and experiences about
the increasing trend in foodborne diseases and the
prevailing food safety risks. This enabled them to reach a
consensus to improve the situation by applying affordable
and practical basic sanitary measures to keep food safe
with the help of environmental health officers and
extension workers. At the end of the workshop
participants came up with a long list of priority
interventions to address the identified risk factors and
formulated an action plan with implementation strategies.
The report of the workshop was published and distributed
to all participants and stakeholders to be used as a
reference educational material to apply basic food hygiene
and environmental sanitation practices and to monitor the
implementation of their plan of action. There are all
indications that food service providers and households are
more concerned than ever before about the benefits of
improving food safety in their community and are making
greater efforts to reduce the burden of foodborne diseases
in Jimma Town. The response of food managers in
particular to this call was reported to be very encouraging.
5. Discussion and Conclusions
The studies demonstrate that food safety is a serious
public health issue in Ethiopia as in other developing
163
countries which has been overlooked in the past by
governments and the public in general. As a result
consumers are exposed to foodborne illnesses due to the
unhygienic practices in the preparation of foods at home
and catering establishments, and poor environmental
health condition of the food premises. The traditional food
inspection system does not provide the necessary tools and
a clear mandate to the agencies concerned to prevent
foodborne diseases. Our research identified varied
knowledge, attitude and practice among households and
food businesses on a number of areas including a lack of
understanding on basic sanitary measures, limited
awareness about food safety and a knowledge gap on
existing food laws, regulations and standards. This raises
the need for a properly designed aggressive public health
campaign supported by risk based food inspection system
as well as national information, education and
communication programmes.
Enforcement objectives of food laws and standards seem
to be driven by punitive measures than educational
approach with minimal effort to help consumers and food
service providers to understand and implement basic
sanitary measures which will have better health results.
Imposing unacceptably high penalty for violating sanitary
rules and regulations did not bring positive results in
improving the safety of food in the past. There is a need for
a renewed emphasis on application of widely recognized
science based inspection system, Hazard Analysis Critical
Control Point (HACCP) to identify and prevent hazards
from the initial stages of raw material production to the
final stages of food preparation and consumption.
Therefore the training of food inspectors in risk based
approach (HACCP) and the provision of inspection tools
and the necessary logistic support to improve their
performance should be taken into consideration by the
regulatory authority. The integration of food safety in the
curriculum of primary and secondary education will also
contribute to transforming hygiene and sanitation behavior
of individuals that will impact the family and the
community.
The study shows that food serving businesses breach
regulations intentionally or unknowingly for different
reasons. Most of the informal food businesses dispute or
disregard the potential health impact of poor food hygiene
practices and do not want to waste time and money on
hazard control. Some food business owners and employees
lack knowledge and training in food hygiene and since they
do not have a clear perspective they want a health inspector
or a third party to give them advice and a list of things they
are expected to do to keep the food safe. A few catering
establishments in the formal sector have a clear
understanding of the hazards and health risks posed by
poor food hygiene and believe that the regulations should
be enforced effectively. These managers encourage their
employees through staff training, regular medical
examination and other incentives to take a lead in applying
164 Transforming Research Results in Food Safety to Community Actions:
A Call for Action to Advance Food Safety in Ethiopia
good hygiene practice of their food business. Under this
circumstances the health inspectors are required to
convince with evidence those who breach the regulations
that their business is at risk unless they take positive action
to comply with the basic food hygiene law. In view of the
current disparity in compliance the managers and their
employees having a problem should be given advice and
training to understand the food hazards and the control
measures and how compliance can be achieved. Managers
and food workers should be encouraged to develop
independent thinking and to understand that it is their duty
to take proactive involvement in improving performance
since inspectors will not be there all the time. Therefore
food inspection needs frequent home visit, face to face
explanation of associated risks, and voluntary compliance
of regulations with a clear understanding of the compliance
process.
The workshop was an eye opener to the participants who
acknowledged that they have learnt a lot from the lectures
given and from the experiences exchanged. They were
committed to use the lessons learnt to change their
approaches to dealing with food safety by preparing action
plan and implementation strategies. They emphasized the
need to train food service managers and workers on how to
minimize food safety risks including direct face to face
discussion in order to bring meaningful changes. Equally
important was the licensing of food establishments and
systematic inspection of premises where food is prepared
and served. The modernizing of existing food safety
legislation and code of practices and defining the role of
the various agencies responsible for food safety was
recognized as an issue of high priority. The licensing of
catering establishments, the medical examination of food
workers, the certification of food service providers, the
provision of basic sanitary facilities including safe drinking
water, clean toilets and adequate waste disposal facilities to
reduce the risk of foodborne diseases were endorsed as
essential ingredients of the food safety control system and
agreed to be enforced at all levels. It was also
recommended to improve the environmental sanitation of
the open markets where perishable raw foods, meat, fish,
milk, eggs, poultry, fruits and vegetables are bought for
consumption at home and food establishments. There was
also a consensus that food safety inspection should be
extended to the primary producers at the farms, and the
informal open markets.
The Government of Ethiopia has declared that it is in
the process of updating and modernizing the country’s
food safety, animal and plant health system. This ongoing
and evolving modernization process is in part attributed to
the nation’s fast-moving, export oriented economic
growth, which has spurred a rising number of retail and
whole sale food outlets, restaurants and food
manufacturers in the new industrial parks. However
Ethiopia’s food safety regime is still in its early stages. At
present food safety is economically driven to take
advantage of international trade opportunities by
increasing exports. On the other hand the health benefits
of safe food by reducing mortality and morbidity from
foodborne diseases in the country and the substantial cost
for hospitalization and treatment of the preventable
diseases has not been well recognized by the concerned
authorities. Our study shows that a lot has to be done to
fill the gap that exists in the health manpower (quality and
quantity of food inspectors), tools, equipment and
laboratory facilities for food examination, legal and
regulatory framework and codes of practice, that make
enforcement difficult. Many of the gaps should be
gradually addressed by increasing public awareness of
food safety through aggressive health education campaign
and enforcing food safety and quality regulations
effectively from farm to fork. The food markets, groceries,
retail shops, the formal and informal food businesses need
substantial structural and sanitary improvements to reduce
the risk of contamination of raw and ready-to-eat foods by
environmental hazards. All the studies carried out in other
cities and towns of Ethiopia (Addis Ababa, Agaro, Bahir
Dar, Mekelle, Zewai) have identified these urgent needs.
This requires the active collaboration and coordination of
the ministries of Health, Agriculture including Fisheries,
Trade and Industry, Tourism, Ethiopian Standard
Institution, National Food Authority, local and municipal
governments and, Consumers Associations.
6. The Way Forward
The decentralization of the Ethiopian Food, Medicine,
and Health Care Administration and Control Authority
(FMHACA) which is the executive organ for food safety
and quality administration and control is a step in the right
direction to make the Authority focus on rendering
efficient regulatory services. However the country’s new
direction being the expansion of agro-industrial parks the
primary objective of modernizing the food safety and
quality control system is to meet international sanitary and
phyto-sanitary standards to fully benefit from regional and
international food trade to boost the economy. Such effort
should at the same time provide opportunity to enhance the
safety of domestic food products by restricting the
manufacturing, importing, storing and distributing for sale
of any food item to the public without permit from the
appropriate organ.
The restructuring of FMHACA should lead to the
establishment of The Ethiopian Food Safety and Quality
Control Authority with branch offices in all the regions
which will be responsible for developing and
implementing of policies that affect food safety, trade and
public health, including capacity to implement relevant
national and international food safety standards and
regulations.
Management of food safety is a multi-sectoral affair in
 Environment and Ecology Research 7(3): 153-170, 2019
Ethiopia involving the ministries of Health, Agriculture,
Fisheries, Trade/Industry the Standards Institution, local
governments and municipalities. The FMHACA should
establish sustainable coordination mechanism with
well-defined responsibilities for each agency at Federal,
Regional, Woreda and local level. Accordingly the
Ministry of Health should play a leading role in the
national food inspection services and take appropriate
measures to improve the professional status of the food
inspectors by providing them with the necessary tools to
perform their duties. The Ministry should also assess the
reliability and relevance of the inspection system and
procedure used, as well as the training provided to the
inspectors in relation to risk assessment of food safety
issues and knowledge in food management tools such as
Hazard Analysis Critical Control Points (HACCP). The
Ministry of Health should ensure that food inspection
services cover the entire country and not be limited to the
formal urban and periurban areas and small towns in a
manner that takes into account priorities in terms of risks to
the consumers. Environmental health officers and health
extension workers who play important role in the food
inspection services should be motivated and provided with
the necessary tools including training to perform their
duties efficiently.
The Ministry of Agriculture regulates pesticides and
other contaminants by conducting pesticide residue
analysis in primary agricultural products as well as sets
limits for heavy metals such as lead and microbiological
contaminants on imported and domestically produced
fruits. The Ministry also sets standard for veterinary drugs
and other related compounds including the safety of
imported plant products as authorized in the Plant
Quarantine Regulation. The Guideline for Import and
Export of Animal Genetic Material spells out the
recommended procedures and requirement. Imports of
livestock, meat, fish dairy products and genetic materials
need health certificate from the country of origin and are
subject to inspection. The import of plants and related
articles must be accompanied by import permit and a
phyto-sanitary certification from the country of origin.
Paradoxically the inspection of primary products such as
cereals, meat, poultry, fish, fruits and vegetables for
residual pesticides, aflatoxin and other chemical, physical
and microbial contaminants at the farm for local
consumption is currently not in line with the food safety
and quality assurance requirements. Therefore the Ministry
should make efforts to ensure the safety of food at the
source of production by engaging agricultural and health
extension workers, assisted by veteran lan. Practices aimed
at improving food safety at the farms also reduce
post-harvest food losses increasing food availability and
should therefore be promoted.
The Ethiopian Standards Agency develops the national
food safety Standards some of which are mandatory while
others are voluntary. Mandatory standards have the force
165
of law and are enforced by laws and administrative
regulations. Food products subject to specific compulsory
requirements are fresh and canned fruits and vegetables,
coffee, non-alcoholic beverages, edible oil seeds, food
additives as well as prepackaged food. However the
Agency is more engaged in the control of the standard of
imported food than food produced for local consumption.
As a result the safety and quality of locally produced food
sold in the open markets, supermarkets and grocery stores
could be of sub-standard since there is no inspection
system for these markets. Hence the Agency should make
efforts to improve the standard and quality of foods sold in
the informal markets to enhance the safety of local food
products in coordination with the Ministry of Agriculture
and Ministry of Health.
The Ministry of Trade has the authority to control the
quality of imports and exports and put restrictions as
necessary when food items that do not comply with the
required national or international standard enter or leave
the country. It works closely with FMHACA, Ministry of
Health and The Ethiopian Standard Agency to fulfill its
mandate. The Ministry has the right to conduct random
sampling and testing to certify that the food product meets
the required standard. The World Trade Organization has
placed a considerable obligation on both importing and
exporting countries to strengthen their food safety system
to comply with the agreement on the application of sanitary
and phyto-sanitary measures. The development of modern
national food safety system for Ethiopia is therefore a
prerequisite to take part in the global food trade and forge
membership to the World Trade Organization.
Foodborne diseases surveillance system is non-existence
in Ethiopia due to lack of efficient food analysis
capabilities at national and regional level. The only referral
public health laboratory in the country is The Ethiopian
Health and Nutrition Research Institute under the Federal
Ministry of Health that has the competence to test for
microbiological and chemical contaminants of food. Due to
the limitation of the surveillance infrastructure there is no
reliable data on the burden of foodborne diseases to
convince policy makers about the public health importance
of allocating funds to prevent foodborne diseases. However
health statistics show that in Ethiopia on average a child
experiences five to twelve diarrhea episodes a year and
more than 250,000 children under the age of five years of
age die annually as a result of diseases related to poor
environmental sanitation and hygiene [4]. Moreover acute
watery diarrhea continues to be a threat to the social and
economic development of the country. Therefore the
establishment of regional and sub-regional food testing
laboratories and the expansion and consolidation of
existing laboratories to include food testing to cover the
entire country will strengthen the food inspection services
and the epidemiological surveillance of foodborne diseases.
In this regard the integration of the food testing laboratories,
to water quality testing or the Antimicrobial Resistance
166 Transforming Research Results in Food Safety to Community Actions:
A Call for Action to Advance Food Safety in Ethiopia
(AMR) microbiology labs will substantially reduce the cost
of infrastructure, equipment and laboratory technicians.
The training of primary health care doctors in
epidemiology to keep records of patients that have been
treated for gastroenteritis, watery diarrhea could be part of
foodborne diseases surveillance activity that could be
extended to the Woreda health centre level.
The most effective intervention to reduce the burden of
foodborne diseases is protecting food from contamination
by pathogenic organisms, viruses, parasites, molds, rodents
toxic chemicals, in the air, water and land. The application
of basic sanitary measures in households, food
establishments, open markets, supermarkets, food
industries and agricultural farms have been recognized as
major preventive strategy. A good example of effective
hygiene intervention is hand washing with soap before and
after contact with food which has been found to have a
substantial impact in reducing the incidence of diarrhea
among the poor. Public awareness, information, education
and motivation to change hygiene behavior and comply
with the food safety laws and regulations can be instituted
by developing a national food safety advancement action
plan with target and implementation strategies. National
efforts to promote behavioral changes with respect to
hygiene and sanitation have been going on in Ethiopia
since 2006 which showed some improvement in both rural
and urban areas. The health extension workers supported
by community volunteers and health development army
were instrumental in bringing the accelerated change.
Equally important for the success of the initiative was the
strong political commitment which was complemented by
signing a Memorandum of Understanding by the Ministry
of Health, Water Resources, Education and Finance, to
harmonize different approaches and provide a clear road
map for resource mobilization, coordination and
implementation of the programme.
Based on the experience and lessons learnt from the
ongoing Community Led Total Sanitation (CLTS)
programme which is being implemented under the
leadership of the Ministry of Health and regional health
bureau, the Ministry of Health is well placed to initiate a
national awareness campaign in consultation with the
ministries of Agriculture, Trade, Ethiopian Standard
Institute, FMHACA on the dangers of the public exposure
to unsafe foods due to inadequate control of food hazards
and deteriorating sanitary condition of food serving
establishments. The consultation should lead to the
establishment of National Food Safety Control Task Force
under the Federal Ministry of Health and different
working groups representing the ministries, agencies and
other organizations responsible for food safety. Under
such arrangement the current National Food Safety
Control System should be reviewed including the various
laws and regulations that have been enacted over the years
to regulate and enhance food safety. The implementation
of policies to ensure compliance and the development of
infrastructure and institutional capacities including the
coordination and surveillance mechanisms should be
assessed. It should be recognized that assuring food safety
along the entire food chain can be made possible by
providing the different stake holders, individuals, families,
communities, farmers, food producers, food traders and
consumers, the information and education necessary to
minimize food safety related risks. Therefore concerted
efforts should be made to enhance effective health
promotion and training programmes as integral part of
National Food Safety Control System in order to achieve
sustainable public health and economic development in
Ethiopia.
7. Recommendations
7.1. Legislation, Policy and Strategies
1. The new Food Safety Authority which has primary
responsibility for food safety should bring the
fragmented national food control system under one
management by establishing a sustainable
co-ordination mechanism with well-defined
responsibilities for each agency and delegate
authorities to Regional, Woreda, Municipal and
Kebele local governments to institute effective food
safety policies and strategies to reduce the burden of
foodborne diseases, and enhance economic growth
and public health development.
2. Review and update existing food safety laws and
regulations in an effort to create modern food law that
ensures the production, distribution and sell of safe
and wholesome food for domestic supply and export
purpose.
3. Formulate national food safety policy and strategies
to provide a basis for the establishment of the food
safety objectives, requirements, and guidance that can
be applied to the various sectors of the food
continuum including primary production, processing,
storage, transportation, marketing, preparation and
consumption. The policy should aim at providing
confidence to consumers and ensure public health.
4. Establish procedures to ensure that regulations,
policies and directives are developed and enforced in
a consistent, transparent and interactive participatory
manner, and that the associated processes are
generally open to the public in a manner that the
objectivity and integrity of all food safety decisions
are made clear.
5. Identify stakeholders who have vested interest in food
safety including institutions, government ministries,
non-government organizations, primary producers,
industries, processors, food service providers,
supermarkets and small food business owners and
consumers, and ensure their participation in all
 Environment and Ecology Research 7(3): 153-170, 2019
aspects of the development and implementation of the
policy.
6. Establish strong and viable inter-ministerial,
inter-agency, and multi-sect oral working committees
to be coordinated by The Food Authority, to articulate
a plan of action to translate the policy into
implementation programmes.
7. Stimulate political will by creating awareness based
on the evidence of situation analysis studies including
records of mortality and morbidity from foodborne
diseases, food adulteration reported cases, as well as
existing and emerging trends influencing food safety
at each stage of the food chain. Political commitment
should stimulate the allocation of adequate resources
by the government by prioritizing the issues and
problems to be addressed.
7.2. Improving the Current Food Inspection System
8. Health inspectors and Extension workers in charge of
inspection of food premises should be flexible to
achieve a better cooperation by using a wide array of
informal techniques such as education, persuasion,
negotiations to remedy existing problems.
Prosecution should be regarded as a last resort unless
there is lack of cooperation and positive response by
the violators. Taking immediate legal action against
offenders may create complications since most Food
Safety Acts do not describe offensive acts in detail
unless accompanied by clear regulations. Thus food
inspectors should be encouraged to practice
educational approach rather than the traditional
command and control food inspection method.
9. The current food inspection system is not effective
due to low concern in national, regional and local
government policies resulting in lack of adequate
resources in terms of priorities for funding, manpower
training, provision of laboratory support for food
analysis, and lack of logistics including transport and
inspection tools. Local governments lack operational
budget and they only pay salaries making it difficult
for the food inspectors to perform their duties
effectively. Since scare government resources are
allocated to priority needs, there is a need for strong
advocacy to provide adequate financial support for
food inspection to make sure that safe and wholesome
food is supplied to consumers.
10. Food inspectors should be empowered to play a vital
role in consumers’ protection even though the
producer, manufacturer and the food service operators
have equal responsibility. Food safety risks arising
from sanitation violation that lead to food
contamination by hazardous substances that may
cause disease outbreak, should be reported to the
appropriate regulatory agency to exercise a direct
influence over food safety risk management.
167
11. Food inspectors should be trained in risk analysis
process which provides a structured systematic
approach to identifying, assessing, and managing
health risks and emphasizes stakeholders consultation
and communication. This is compatible and
consistent with approaches developed at the
international level by the Codex Alimentarious
Commission and with the guidance on food safety
risk analysis provided by FAO/WHO.
12. With major institutional changes for food safety that
led to the establishment of the Food Safety Authority,
the inspection of major agro industries in the Agro
Industrial Parks, large food manufacturing and
processing enterprises, commercial agriculture,
poultry and dairy farms, fisheries, abattoirs,
supermarkets, large hotels, restaurants and mass
catering institutions should apply risk based
regulatory system for which specialized knowledge is
required by the food inspectors. The food inspectors
assigned to these high profile food enterprises should
therefore be trained in the Hazard Analysis Critical
Control Points (HACCP) principles while small and
medium businesses continue to be inspected by
command and control system with a wide array of
informal techniques such as education, persuasion
and negotiations.
7.3. Hygiene Compliance of Food Establishments
13. Strengthen the capacity of local authorities to
implement effective food inspection services on
regular basis by playing a role as educators rather than
enforcers and by providing them with the enabling
policy, legislation, strategies, code of food hygiene
practices and resources.
14. Extend the food inspection service to the informal
sector open markets, street food vendors and to the
rural areas where primary products are collected from
thousands of small holdings ultimately reaching the
urban population through local traders in the supply
chain for direct consumption. Several studies confirm
that small food businesses and street food vending
pose significant health risk to consumers due to lack
of knowledge of street vendors on basic food hygiene
and the exposure of street foods to environmental
hazards (chemical, physical, biological).
15. In view of the deplorable sanitary and environmental
condition of food establishments particularly small
hotels, restaurants, and open food markets in the
urban areas, the regulatory authority should pay due
attention to improve the condition by ensuring the
availability of safe water, clean toilet facilities with
hand washing basins and appropriate solid and liquid
waste collection and disposal system. Particular
attention should be given to maintain a good repair of
the kitchen where there is greater risk of cross
168 Transforming Research Results in Food Safety to Community Actions:
A Call for Action to Advance Food Safety in Ethiopia
contamination and temperature abuse due to improper
washing of utensils and unsafe storage of perishable
and ready to eat food stuff including contact with food
handlers who do not practice good personal hygiene.
16. Develop or use existing educational materials
prepared for food workers and managers by WHO,
FAO and others to engage them in food hygiene and
restaurant procedure training in order to fully
understand the factors that impact food safety in the
food service establishments. At the same time
motivate the employees who have acquired basic
knowledge of safe food preparation and handling by
providing them the necessary support to develop and
implement activities that would contribute to
effective food safety management.
17. Encourage food business managers to maintain
acceptable sanitary and hygiene standard of their food
premises by providing them health information and
familiarizing them with the existing regulations and
code of practices during regular inspection. Managers
should receive a copy of the inspection report and be
advised on important issues such as the requirement
for medical examination of the food handlers, timely
renewal of their licenses, use of proper equipment and
utensils and, allocating time and resources for training
of staff.
7.4. Open Markets and Street Food Vending
18. Empower open market food traders and street vendors
to become an integral part of the urban and rural life
by providing them permanent built up structure at
convenient locations with facilities to store and
display food safely without risk to contamination by
pathogenic organisms, dust, chemicals and extreme
heat. The construction of municipal owned rental
modern food kiosks or stalls to house the street
vendors and open market food traders will add to the
safety and well-being of consumers. The current
practice of food vending in the urban areas gives a bad
image to the municipal health authorities due to
exposure of perishable and ready to eat food stuff to
environmental hazards.
19. Register street food vendors and organize them to
form associations or unions or cooperatives to get
approval of the local authorities and enable them to
have operational guidance, get loans from banks to
expand their business and invest in infrastructure
development. Since vendors prepare food at home
and on site there is a need to educate them on food
hygiene and to make them aware of the importance of
taking regular medical examination. Food samples
should also be taken for bacteriological examination
by the health inspectors on regular basis as preventive
control.
20. Make special provision on the sanitary requirement
for the storage and sell of perishable and ready-to-eat
foods such as meat in butcheries shop, milk and milk
products, fish, eggs, chicken fresh fruits and
vegetables, bread and juices to ensure that these food
items are kept under temperature that retard the
growth of pathogenic organisms. Provide manuals on
the hygiene requirements of these food stuff.
7.5. Foodborne Disease Surveillance, Education and
Communication
21. Increase the capabilities for microbiological and
chemical analysis of food to cover all regions by
establishing more laboratories to implement
foodborne disease surveillance programme. In this
regard consideration should be made to integrate
foodborne disease surveillance system to existing
water quality surveillance or Antimicrobial
Resistance (AMR) microbiology labs to reduce the
cost of infrastructure, equipment and laboratory
technicians.
22. Monitor trends in foodborne diseases caused by the
key pathogenic bacteria Salmonella, Campylobacter,
Listeria, E.coli and Mycobacterium through
laboratory confirmed cases of illness when someone
suffering from foodborne disease symptoms is sent to
a laboratory by a health care provider to give stool
sample. Although we can’t be sure exactly how many
cases of food poisoning there are, we can make
reasonable estimate s of trends and tell whether the
number of cases is going up or down. Another way of
estimating trend is using telephone survey to
determine the total amount of infectious
gastroenteritis in a typical year or collecting
epidemiological data from hospitals and other health
facilities on the number of cases, hospitalizations and
deaths due to foodborne gastroenteritis. Although
these confirmed cases only represent a fraction of the
total, the system doe provide a consistent indication
of trends in some of the key foodborne diseases
caused by the pathogens.
23. Create national awareness about the health and
economic threats of the rapidly increasing foodborne
diseases due to the poor sanitary condition of the
environment where our food is produced, marketed,
prepared and consumed and due to unhygienic
practice of food handling in the domestic and food
serving establishments. An even greater challenge to
food safety will come as new pathogens are identified
from climate change, changes in ecological system,
production methods, processes and habits.
Antimicrobial resistance is the most alarming threat
resulting in deaths.
24. Initiate and implement national educational campaign
to keep food safe from farm to table by mobilizing
 Environment and Ecology Research 7(3): 153-170, 2019
stake holders and organizing community meetings,
training workshops, useof extensive public media,
radio programmes, public speeches, and distributing
posters, fliers, and manuals on basic hygiene
practices.
25. Ensure the application of best practices, standards,
regulations and scientific approaches to risk
management such as “HACCP” by large food
processing and manufacturing industries to avoid the
risk of food recalls by national and international trade
partners.
26. Promote proactive engagement of consumers by
organizing them in association at different levels, to
be involved in food alert, adulteration and other
fraudulent activities. Consumers should be educated
how to keep food safe to prevent foodborne diseases
so that they become part of the solution and demand a
safe food supply.
27. Raise consumers’ confidence by informing and
educating them on safe food preparation and handling
in the domestic environment. Most consumers are
aware of major food contamination sources and are in
favor of implementing measures that reduce risk of
foodborne illnesses but they lack adequate knowledge
and therefore have to be informed and technically
guided. Public consciousness of food adulteration and
contamination will contribute to the early detection of
fraud and hazard before the damage occurs.
28. Integrate food hygiene in the curriculum of primary
and secondary education so that good hygiene
behavior becomes part of the way of life of the young
generation contributing to the health and economic
wellbeing of individuals, families and communities.
29. Review the Environmental Health undergraduate
degree programme to ensure food safety is adequately
covered to address the country’s need including risk
assessment and management, food processing critical
control points, food packaging, labeling and food
defense.
30. In view of the scientific and technological
development of food processing and the growing
trend of agro industrial parks in the country, establish
a department of Food Science and Technology to
train food technologists and scientists for innovation
and research in safe food production.
Acknowledgements
We are very grateful to all food safety study and
workshop participants for their valuable supports and
cooperations.
169
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